This article examines the policy lessons to be learned from the American experience with the End-Stage Renal Disease program. This program was instituted in 1972 as an amendment to the Social Security Act to provide reimbursement for the costs of therapy to those persons suffering from renal failure. The article tries to debunk certain common myths that have arisen concerning the ESRD program, by examining the history and evolution of renal dialysis technology as well as the social policies concerning dialysis pursued in England and Sweden. It argues that while the ESRD program is not a genuine instance of a ‘mini’ national health insurance program, there are important moral, social, and policy lessons to be learned from this unique effort to provide renal therapies to those Americans in need.